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Computed Tomography Usage For ED Patients With Suspected Appendicitis Following Implementation Of A Scoring-System Based Protocol
*Cecilia Trydestam1, Jonathan Dreifus1, *Christopher Bowe1, *Tania Strout1, *William Gregorie2
1Maine Medical Center, Portland, ME;2Central Maine Medical Center, Lewiston, ME

Objective: To compare the rate of CT usage in emergency department patients diagnosed with appendicitis before-and-after implementation of an Alvarado score-based to guide implementation of CT scan for diagnosis
Design: Non-randomized control study
Setting: 600 bed tertiary referral hospital
Patients: Adult (> 15 yo) presenting to emergency department with symptoms concerning for appendicitis
Interventions: Utilization of 7 or 10 point Alvarado score to determine timing of CT and surgical consultation appendectomy as indicated by clinical and imaging presentation
Main Outcome Measures: Chi-square analysis was used to assess for differences in the proportion of patients receiving CT imaging during the two study periods while Fisher’s exact test was employed to compare negative laparotomy rates
Results: 647 patients diagnosed in the ED with appendicitis, of whom 112 were excluded, leaving 435 subjects for analysis: 213 (49%) from the pre-intervention period and 222 (51%) from the post-intervention period. CT was performed in 187 (88%) and 194 (87%) of subjects in the pre-and post-implementation phases, a difference that was not statistically significant. Eight cases (4%) of negative laparotomy were identified during the pre-intervention period while 2 cases (0.9%) were identified post-intervention, a difference that approached but did not reach statistical significance
Conclusions: The implementation of an Alvarado score-based protocol did not reduce the proportion of patients receiving CT imaging prior to operative intervention. While a trend towards a lower negative laparotomy rate was noted during the post-intervention phase, this reduction did not reach statistical significance

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Abstract Submission Deadline:
May 5, 2014

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August 13, 2014

Early Bird Registration Deadline:
August 11, 2014
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